health nurses this is a master’s degree. Because no residency is involved, a doubling of the annual number of master’s-level occupational health nursing graduates is not an unrealistic goal if established professionals are not required to abandon an ongoing career for a year or more. Chapter 8 explores some emerging means of accomplishing this.

The distinction between demand and need is nowhere more aptly illustrated than by examination of the makeup of the U.S. workforce as a whole. Some 56 percent of U.S. workers are employed by firms with less than 100 employees (National Institute for Occupational Safety and Health, 1999). The majority of the traditional OSH professionals, however, are employed by midsize to large businesses and government agencies. Small businesses as a group apparently believe that they do not need OSH professionals or cannot afford them. Most workers will thus seldom, if ever, encounter one of these OSH professionals. Even when injured, they may receive treatment in emergency rooms or ambulatory clinics where the treating physicians and nurses have neither the time nor the training to deal with issues of causation and prevention of the injury-producing event.

The training of traditional OSH professionals is considerably simplified by the nature of their practice in midsize and large industries and government agencies. To a large degree the framework is constructed around the regulatory system and the workers’ compensation insurance system. It is a top-down system that, for those segments of the economy, reaches all the way to the worker at risk. This part of the system includes professionals who operate from consulting practices and who play an increasing role in midsized industries. It is another matter entirely to address the development and the training of OSH personnel to deal with that large majority of the workforce who have no routine access to the OSH system. The few OSH professionals who do focus on small businesses and workplaces are likely to work for government or public interest groups. For these professionals, media and communication skills are likely to be the most important requirement. For example, the “right-to-know” concept was popular in the 1980s occupational and environmental health community as a means of stimulating a bottom-up demand (i.e., turning a need into a demand) for a safer and healthier environment among those directly affected. Putting that approach to work in the workplace, however, continues to be a challenge and, on the prevention side at least, the OSH system in the United States principally affects that portion of the workforce that is employed in large industry or by government or that is represented by organized labor. As subsequent chapters will elaborate, the workplace of the future will increasingly be dominated by small service-producing businesses that are widely distributed and that utilize an increasingly diverse and transient workforce. What is most needed



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